Is your child bringing any medication with him/her? If yes, please list, including drug name(s), condition(s) prescribed for and dosage/times required. (Note that medications must come in original packaging from pharmacy.)

Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of? If yes, please explain.

Group placement request (we attempt to satisfy requests to be placed in the same group as another camper of the same gender)

Authorisation and Medical Consent

Parent's name*

The name of your church*

How did you find out about our camp?*

Referred By

Phone*

Work (daytime) phone*

Parent's Email*

Address*

Child's health card number*

Picture or scan of health card (to verify child's date of birth and health card number. If not provided, health card MUST be brought on the first day for verification)

Child's family doctor

Family doctor's phone number

In case of an emergency, contact

Please click off your preference(s) for water activities (choose all that apply)

Not allowed to swimAllowed to swimNeeds life jacket to swim (please bring your own)Allowed to swim in deep waterAllowed to go tubingAllowed to go water skiing

Who will be picking up your child (list all possibilities, indicate self-dismissed if your child is able to be dismissed on his or her own)?*

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection.

I/we, the parents or guardians named above, authorize Good News Gospel Outreach to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we certify that any and all physical, medical, emotional, mental or behavioural weaknesses or issues are fully disclosed with the registration. Failure to disclose weaknesses or issues at the time of registration could result in dismissal without refund. The Camp Director also reserves the right to dismiss a camper who is in his/her opinion a hazard to the safety and rights of others, or who appears to him/her to have rejected the reasonable rules and controls of the Camp. The signature on the registration form signifies that both parents/guardians are in agreement with the conditions of enrolment.

I/we, named above, undertake and agree to indemnify and hold blameless Good News Gospel Outreach, and its Directors from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Good News Gospel Outreach, as well as of any medical treatment authorized by the supervising individuals representing the church. I/we, named above, agree that photography may include the image of the participant named above, and may be used for promotional purposes.

This consent and authorization is effective only when participating in or traveling to events of the Good News Gospel Outreach for the period of July 2019-June 2020. I/we give permission for my child to leave the camp property for any Camp excursions that may occur offsite.

I have read, understood and agree with the above and by checking here authorize my child's participation in Youth Upward Teen Bible Camp 2019, as well as in Good News Gospel Outreach activities for the 2019-2020 year.*

Date*

Discount Code (when you click submit you will be taken to our payment page and if you have a discount code, it will be applied)

I/we, named above, agree that Good News Gospel Outreach may periodically send emails to the email identified above regarding our programs in the community. I understand that consent can be withdrawn at any time.*